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Comments on Primary Papers and News

There is considerable evidence indicating that many forms of heart disease and embolic stroke in elderly people are major risk factors for Alzheimer disease (AD). This is a monumental medical problem when one considers that heart disease and stroke are the leading causes of death and long-term disability in the United States and in the industrialized world. Thus, elderly patients that survive heart disease or stroke may have a good chance of ending their life with AD. Now, Dr. Purandare and his colleagues show that spontaneous cerebral emboli, which can occur in patients with carotid artery or cardiac pathology, are significantly more frequent in both Alzheimer disease and vascular dementia (VaD) when compared to a nondemented control group. This group found that the similar frequency of emboli in both AD and VaD suggests that both dementias share coincident risk factors and a common pathophysiological cause.

These findings by the Manchester-based investigators seem to add fuel to the often-made postmortem observation that it is unusual for a patient with AD to die without evidence of some vascular-related condition that causes a reduction in cerebral blood flow. A final point to be made from the Manchester study is that assessment of spontaneous cerebral emboli was made using a transcranial Doppler technique (TCD) of cerebral blood flow signals. I have predicted TCD one day will become a cost-effective, standard office tool to detect potential AD patients with high accuracy (de la Torre, 2005). Such an approach would ideally target preventive treatment of candidate AD patients prior to widespread neurodegeneration.